Provider Demographics
NPI:1295929404
Name:OPTOMETRIC PROVIDERS OF RHODE ISLAND, INC
Entity type:Organization
Organization Name:OPTOMETRIC PROVIDERS OF RHODE ISLAND, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:R
Authorized Official - Last Name:IANNUCCILLI
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:401-782-2100
Mailing Address - Street 1:91 POINT JUDITH RD
Mailing Address - Street 2:OPTOMETRIC PROVIDERS OF RHODE ISLAND, INC
Mailing Address - City:NARRAGANSETT
Mailing Address - State:RI
Mailing Address - Zip Code:02882-3468
Mailing Address - Country:US
Mailing Address - Phone:401-782-2100
Mailing Address - Fax:401-782-2101
Practice Address - Street 1:2921 ERIE BLVD E
Practice Address - Street 2:EMPIRE VISION CENTER, INC
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13224-1430
Practice Address - Country:US
Practice Address - Phone:516-827-6727
Practice Address - Fax:800-350-1516
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-30
Last Update Date:2009-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty